Marion County could get needle exchange program, as hepatitis C rates soar

The controversy centers around needle exchanges in Scott County that were made in response to an HIV outbreak in 2015.
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Free needles at Scott County's needle exchange program. Scott County became the first in the state to run such a program after more than 200 people in that county developed HIV linked to intravenous drug use.(Photo: Kelly Wilkinson/IndyStar)Buy Photo

As Marion County sees its hepatitis C rate soar to epidemic proportions, local health officials Thursday called for the county to start the state’s eighth syringe exchange program.

More than 150 public health officials, doctors, first responders and others on the front lines of the opioid crisis gathered to hear Dr. Virginia A. Caine, director of the Marion County Public Health Department, share the data that led her to support establishing such a program.

In just four years, from 2013 to 2017, the number of reported acute hepatitis C cases in Marion County increased 1,000 percent. The vast majority of those diagnosed, more than 85 percent, reported having injected drugs in the past six months. At least 58 percent of those diagnosed said they had shared needles.

“Such a program is medically necessary and will save lives,” Caine said. “There are very troubling statistics facing our county.”

And the actual number of those infected with hepatitis C is likely about 14 times higher, according to the Centers for Disease Control and Prevention, since about 80 percent of people who develop hepatitis C have no symptoms in the early part of the disease. That would bring the total number of new hepatitis C cases in Marion County in 2017 to about 1,000, Caine said.

A viral infection, hepatitis C is most commonly acquired through intravenous drug use. It can lie dormant for years but then result in severe illness, including liver damage and cancer.

City-Council of Marion County and Indianapolis President Vop Osili called the proposal a “no brainer” and said it currently has more than enough bipartisan votes to pass. He said it would be introduced for consideration at Monday’s meeting and could pass as early as June 18th.

If that occurs, the program could start as early as August, Caine said. In its first year, the program will operate out of a mobile unit, hitting zip codes with the highest rates of drug use, health department officials said. Eventually, the department hopes to open at least one storefront site.

Many have been looking to the health department to take this step for months, noting that the opioid crisis has shown no sign of abating in Marion County.

Dr. Krista Brucker, an emergency room physician at Eskenazi Health, has long hoped for this to happen. As one of the founders of Project Point, a program that aims to connect those who overdose with recovery services, Brucker sees firsthand those most affected by opioid use.

While she said she would have liked to see such a program start earlier, she said it made sense for the health department to make sure all the major players agreed before moving forward.

“When (needle exchange programs) don’t have robust community support, they’re very fragile," said Brucker, noting that some counties have already disbanded programs they started. “They’ve taken the time to make sure they have all the people on board.”

The Marion County Public Health Department will fund the program with its own budget and apply for additional grants to support it, Caine said. In its first half year, she estimated, it will cost about $200,000 to run.

Participants will receive a random ID code so the program can track how many syringes go out and are returned, said Madison Weintraut, a nurse epidemiologist with the Marion County Public Health Department. In addition to providing participants with the overdose-reversing drug naloxone, the program will provide rapid hepatitis C and HIV testing, assist participants with finding health insurance, places to stay and will link them if they are interested to recovery resources.

Studies show that those who participate in syringe exchanges are five times more likely to enter recovery programs, Weintraut said.

“This is a first step for treatment for many. We’re increasing access to a population that usually wants to hide,” she said.

While many may think that the opioid epidemic has no impact on their lives, it goes beyond those who use drugs, Caine said.

In recent years, the county has seen a 64 percent increase in children placed in foster care, largely due to the drugs, he said.

The number of ambulance runs due to opioids has quadrupled since 2012, going from 536 to more than 2,130 in 2017.

“We have had to more ambulances, increase our staff capacity,” she said. “If you’re having a heart attack…you’ve got to compete with these Narcan runs. They may delay how long it takes you to get to the emergency room.”

During Thursday’s announcement Caine and other officials made frequent reference to Scott County, which in 2015 saw the start of an HIV outbreak connected to intravenous drug use that has now surpassed 200 cases.

While the largest increase in hepatitis C cases has occurred in the white population here, particularly among young adults ages 18 to 44, in Marion County black men have seen the highest increase in HIV, Caine said.

The overall rate has gone from 20 cases per 100,000 population in 2015 to 25.3 cases per 100,000 in 2017. The rate of HIV in African Americans males has increased to 89 per 100,000, Caine said.

Although HIV here seems to be linked more to male sexual encounters than drug use, Caine said, all it would take for HIV to spread here would be for one person in the community that uses intravenous drugs to get infected.

When that happened in Scott County, a 45-fold increase in the number of cases of HIV followed, Weintraut said. An increase of that magnitude would translate into 540 cases of HIV here.

Paying to care for that many people with HIV would cost about $500 million, about half of the total City Council budget, Osili said.

“This program will save taxpayers and health care providers millions, but more importantly will save lives,” he said.

The Marion County Public Health Department plans to hold three public meetings, May 21, May 31 and June 13 to solicit comment on the proposal.

Call IndyStar staff reporter Shari Rudavsky at (317) 44-6354. Follow her on Facebook and on Twitter.